Relationship Of Pregnant Mother's Anxiety Levels During The Covid-19 Pandemic On ANC Visit At Puskesmas Sukatani Bekasi

The spread of the Covid-19 pandemic in Indonesia has made vulnerable groups more susceptible to contracting this virus. One of these vulnerable groups is pregnant women. More and more pregnant women in Indonesia are positive for Covid-19. Pregnant women who are infected with the Covid-19 virus are more likely to give birth to babies early in premature conditions. During the Covid-19 pandemic, many pregnant women were afraid to have their pregnancy checked. Anxiety when they want to do a pregnancy check is often felt by pregnant women during a pandemic corona virus. Analytical research using the "cross-sectional" method. The sample in this study amounted to 178 respondents. The sampling technique used was accidental sampling. The research instrument is a questionnaire. Data were analyzed using univariate and bivariate with chi square statistical test. Univariate results showed the majority of severe anxiety levels and the majority of ANC visits were irregular. The results showed that there was a significant relationship between the anxiety of pregnant women during the Covid 19 pandemic and ANC visits with a p value <0.05.


INTRODUCTION
At the beginning of 2020, the whole world was shocked by the emergence of a new virus, namely a new type of coronavirus called SARS-CoV-2 and the disease caused by this virus is called Coronavirus disease 2019  where these numbers indicate the first year of discovery. This virus was discovered in Wuhan City, China in December 2019. On March 11, 2020, WHO declared this outbreak to be a pandemic outbreak because it spread so quickly to various countries 1 Based on WHO data on September 9, 2020, from 216 countries there were 27,236,916 confirmed cases, and 831,031 deaths. Meanwhile, data in Indonesia alone on the same date recorded 200,035 confirmed cases, 8,230 deaths, and 142,958 cure rates. 2 The spread of the Covid-19 pandemic in Indonesia has made vulnerable groups more susceptible to contracting this virus. One of these vulnerable groups is pregnant women. More and more pregnant women in Indonesia are positive for Covid-19. In several regions in Indonesia, such as in Yogyakarta, 6 pregnant women were found to be positive for COVID-19, in Surabaya there were 123 pregnant women who were positive for Covid-19, in Gresik there were 20 pregnant women who were positive for Covid-19 and in the Lampung region, there were also three pregnant women who were positive. Covid-19 can cause a variety of clinical manifestations ranging from mild signs and symptoms, such as fever, cough, sore throat, myalgia, and malaise, to severe signs and symptoms, such as pneumonia with or without acute respiratory distress syndrome (ARDS), kidney failure, and multiorgan dysfunction that may require immediate follow-up critical care support. The elderly group with comorbidities or groups with a history of respiratory disease, women with pregnancy are also included in the group of patients who are susceptible to the progression of COVID-19 symptoms. Clinical presentation in pregnant patients with COVID-19 may be atypical with normal temperature (56%) and leukocytosis 6 The coronavirus has disrupted pregnancy plans and heightened the anxiety of most expectant mothers, who question how the virus will affect the birth of their babies. Doctors say more studies are needed to determine the impact of the virus on fetuses and babies. But the best thing for pregnant women to do right now is to practice social distancing. Most pregnant women feel anxious about giving birth without their loved ones by their side. Others are afraid of being infected with COVID-19 and not being able to hug their baby 7 During the Covid-19 pandemic, many pregnant women were afraid to have their pregnancy checked or Atenatal Care (ANC). Actually, this is nothing to be afraid of because health services have certainly implemented health protocols that can prevent the transmission of Covid-19. Antenatal Care or ANC is highly recommended for every pregnant woman,Minimum of 4 meetings namely in the first trimester once, in the second trimester once, and in the third trimester 2 times. This ANC aims to determine the development of the fetus in the womb and monitor the health of the mother. So, everything that is harmful during pregnancy can be prevented so that mothers can give birth to healthy babies safely 8 Pregnancy is one of the best moments for a woman. However, pregnancy can also be a very stressful time for many reasons. A study based in the United States, found that 84 percent of pregnant women experience some level of stress during their pregnancy. Another study published in the British Journal of Psychiatry found that the percentage of pregnant women suffering from anxiety continued to increase with each trimester. Especially during conditions like today, where there is a global pandemic that cannot fail to end. With restrictions due to Covid-19, the number of women suffering from anxiety and depression is expected to continue to rise. Especially with vital support groups, clinics and classes cancelled, a woman has to give birth on her own due to isolation and social distancing restrictions 9 Anxiety in pregnant women can affect the health of the mother and baby. With the Covid-19 pandemic, it can increase the incidence and level of anxiety in pregnant women, so these cases require further action, to reduce the negative impact on the welfare of mothers and babies. 10 Psychological disorders during pregnancy in existing literacy have been associated with various complications, such as premature birth, low birth weight, stunted fetal growth, and postnatal complications. In addition, this psychological disorder is also associated with the emergence of hypertension during pregnancy, preeclampsia, and gestational diabetes 11 pandemic is that if generally there are K1 to K4 or the number of visits, it can also be controlled every month in each trimester of pregnancy, but during the pandemic, the number of visits is reduced. In the first trimester, it is expected that only once and screening is carried out to see if there are complaints or symptoms related to infection, as well as an examination related to risky health history, such as diabetes, hypertension or other things. While in the second trimester, one visit is made to screen the condition of the pregnant woman or whether there are abnormalities that occur in the fetus. In the second trimester, there are those who recommend not to visit. Then, in the third trimester, then more routine and intense visits may be made considering that the condition is approaching the delivery process. In accordance with what has been agreed by the relevant agencies, at term or above 37 weeks of gestation, they are asked to do a swab test, as a form of self-protection for pregnant women and their fetuses. 12 Preliminary studies that have been conducted on 5 pregnant women, it was found that out of 5 pregnant women said they were very anxious to do ANC at the Puskesmas for fear of contracting the  From the data that has been tabulated and then analyzed with the chi square test using SPSS and the value (0.002) < (0.05) it can be interpreted that there is a significant relationship between the anxiety of pregnant women during the Covid 19 pandemic and ANC visits.

DISCUSSION
The relationship between the anxiety of pregnant women during the Covid 19 pandemic and ANC visits.
Anxiety is a conscious (effective) disorder characterized by feelings of fear or concern that are deep and ongoing, do not experience disturbances in assessing reality (Reality Testing Ability / RTA), are still good, personality is still intact (no splitting of personality). ), behavior can be disturbed but still within normal limits 8 From the results of the study above, it can be seen that of the 80 respondents who experienced the most mild anxiety, 48 respondents (60.0%). ,3%). The results showed that the Chi-Square statistical test obtained a value of p.0.002 (p.value <0.05), which means that there is a significant relationship between the anxiety of pregnant women during the Covid 19 pandemic and ANC visits.
In a study comparing the prevalence of increased anxiety symptoms, it was found that the general prevalence of anxiety in the US in 2019 was 16%. The percentage of anxiety during pregnancy by metaanalysis reporting the prevalence is 18-25%. 9 Meanwhile, during the COVID-19 pandemic, there was a significant increase in anxiety in pregnant women to 59%. These results indicate that anxiety has increased because of the consequences of worrying about the COVID-19 pandemic. 9 Pregnancy is a period in which the body of a pregnant woman undergoes changes, both physiologically and psychologically. These changes are largely due to the influence of hormones, namely an increase in the hormones estrogen and progesterone. Hormonal changes that take place during pregnancy also play a role in emotional changes, making you feel erratic, lose concentration and often feel dizzy. This causes the mother to feel uncomfortable during pregnancy and triggers stress, which is characterized by the mother being often moody. Significant changes occur psychologically from within the mother and partner during the pregnancy process 7 Pregnant women who experience mild anxiety related to tension in daily life and cause an increase in the field of perception. Moderate anxiety causes the perception of the problem to decrease. The individual has focused on the things that are important at the time to the exclusion of everything else.
Moderate anxiety responses such as frequent shortness of breath, increased pulse and blood pressure, dry mouth, red and pale face, anorexia, anxiety, narrowed visual field, external stimuli can be accepted, talk more and more quickly, difficulty sleeping and feeling bad, bad feeling . Anxiety weight field of individual perception is very narrow. A person tends to only think about small things and ignore the important things. Inability to think hard and need more direction, support or demands. Responses include shortness of breath, 8 According to the results of research at the Sukatani Health Center, Bekasi, most pregnant women who regularly visit ANC are pregnant women with mild anxiety, this is because pregnant women with mild anxiety dare to come to health services to check their pregnancy considering ANC examination is very important to monitor developments. fetus in the womb and pregnant women know that there are many risks that will occur if ANC is not performed. For pregnant women who do not regularly make ANC visits, most of them are pregnant with severe anxiety, this is because pregnant women with severe anxiety are afraid to do activities outside the home for fear of contracting Covid 19 for which until now